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CYP2C19 is responsible for the metabolism of approximately 10% of drugs currently on the market, including several proton pump inhibitors, clopidogrel, benzodiazepines and some tricyclic antidepressants, including amitriptyline. It is a cytochrome whose activity is characterized by a great variability in the general population. This variability can be explained, in part, by genetic and environmental factors The classification of phenotypes associated with CYP2C19 has evolved over time. Today, five distinct phenotypes are used to characterize this variability: the slow metabolizer (SM) phenotype, the intermediate metabolizer (IM) phenotype, the normal metabolizer (NM) phenotype, the fast metabolizer (RM) phenotype and finally the ultra-fast metabolizer (UM) phenotype. (UM) phenotype.
Although directly measurable with test substances, CYP2C19 phenotypes are often assigned on the basis of genotype. They may be impacted by intrinsic (e.g., comorbidities) or extrinsic (e.g., co-medications) factors. Phenoconversion or phenotypic change is the phenomenon by which an individual switches from one phenotype to another due to an environmental influence such as a drug interaction. However, genotype is likely to influence the degree of response to a drug interaction. Vulnerability to phenoconversion therefore differs according to the genotype of the individual.
The purpose of our study is to determine whether individuals genetically MR, NM and IM have the same vulnerability to phenoconversion. Thus, the magnitude of the response to CYP2C19 inhibition will be studied in these 3 groups of individuals (NM:*1/*1, RM:*1/*17 and IM:*1/*2-*2/*17). Inhibition will be studied in two steps, using a strong (fluvoxamine) and a weak (voriconazole) inhibitor of CYP2C19.
Phase 1, open-label, parallel study in healthy volunteers selected according to their genotypic belonging to one of the three study groups.
Volunteers are included in the study and go through a buccal swab for genotyping, allowing their allocation into 3 groups according to their CYP2C19 genotype (RM: *1/*17 - NM: *1/*1 - IM: *1/*2 and *2/*17).
Following this step, volunteers have an inclusion session to determine if they meet the inclusion and non-exclusion criteria for the study.
The included volunteers will participate in three study sessions will take place.
Session 1 (control session): administration of 10mg of omeprazole for CYP2C19 phenotyping Session 2: same as session 1 with a prior intake of voriconazole 400 mg (weak inhibitor of CYP2C19 2 hours before omeprazole intake) Session 3: same as session 1 with a prior intake of fluvoxamine (strong CYP2C19 inhibitor, 12 h before and 2 h before taking the omeprazole)
At each session, dried blood spot (DBS) samples will be collected before the intake of the omeprazole (T0) and then at 2, 3, 6 and 8 hours after taking the capsule.
A wash-out period of minimum 3 days will be observed between session 1 and 2 and of minimum 1 week will be observed between sessions 2 and 3.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| CYP2C19 Rapid Metabolizers (RM) | Experimental | CYP2C19 rapid metabolizers (RM) are characterized by one normal function allele and one increased function allele |
|
| CYP2C19 Normal metabolizers (NM) | Experimental | CYP2C19 normal metabolizers (NMs) harboring two normal function alleles defined by the lack of any characterized polymorphisms. |
|
| CYP2C19 Intermediate metabolizers (IM) | Experimental | CYP2C19 intermediate metabolizers (IMs) are characterized by the presence of one normal function allele and one no function allele or one no function allele and one increased function allele. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Voriconazole 200mg | Drug | Voriconazole is a weak CYP2C19 inhibitor. It is used in study session 2 to study the impact of a weak inhibitor on the phenotype switch among the different genotypes included in the study. |
| Measure | Description | Time Frame |
|---|---|---|
| Phenoconversion rate | The proportion of volunteers in each group who acquire a phenotype switch such as from NM to PM after pre-treatment by voriconazole and fluvoxamine (weak and strong inhibitors, respectively) | 2 months |
| Measure | Description | Time Frame |
|---|---|---|
| AUC assessment | Test drugs and their metabolite AUC measurement in whole capillary blood as well as metabolite /probe AUC ratio and single points metabolic ratios. | 1 year |
| CL assessment | Test drugs and their metabolite Cl measurement in whole capillary blood |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Role | Phone | Extension | |
|---|---|---|---|---|
| Youssef Daali, Prof | Contact | 022395430 | Youssef.daali@hcuge.ch | |
| Kenza Abouir, PharmD | Contact | 0788918021 | kenza.abouir@unige.ch |
| Name | Affiliation | Role |
|---|---|---|
| Caroline Samer, Prof | Division of Clinical Pharmacology and Toxicology, Department of Anesthesiology, Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Geneva University Hospitals, HUG | Recruiting | Geneva | Switzerland |
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The study will include 3 distinct CYP2C19 genotype groups that will constitute the 3 arms of the study. For each volunteer, the study will consist of 3 sessions. Same drugs will be administered to the 3 arms of the study.
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| FluvoxaMINE 50 Mg Oral Tablet | Drug | Fluvoxamine is a strong CYP2C19 inhibitor. It is used in study session 3 to study the impact of a strong inhibitor on the phenotype switch among the different genotypes included in the study. |
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| Omeprazole 10 MG Oral Tablet | Drug | Omeprazole is a CYP2C19 probe substrate. It is used in the study as a tool for CYP2C19 phenotyping at each of the sessions. |
|
|
| 1 year |
| Cmax assessment | Test drugs and their metabolite Cmax measurement in whole capillary blood | 1 year |
| Tmax assessment | Test drugs and their metabolite Tmax measurement in whole capillary blood | 1 year |
| ID | Term |
|---|---|
| D065819 | Voriconazole |
| D016666 | Fluvoxamine |
| D013607 | Tablets |
| D009853 | Omeprazole |
| ID | Term |
|---|---|
| D014230 | Triazoles |
| D001393 | Azoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |
| D010091 | Oximes |
| D006898 | Hydroxylamines |
| D000588 | Amines |
| D009930 | Organic Chemicals |
| D004304 | Dosage Forms |
| D004364 | Pharmaceutical Preparations |
| D053799 | 2-Pyridinylmethylsulfinylbenzimidazoles |
| D013454 | Sulfoxides |
| D013457 | Sulfur Compounds |
| D011725 | Pyridines |
| D001562 | Benzimidazoles |
| D006574 | Heterocyclic Compounds, 2-Ring |
| D000072471 | Heterocyclic Compounds, Fused-Ring |
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